Women and Depression
One of the most universal findings in depression research is the higher rate of major depression and dysthymia in women. An average of two women experience major depression or dysthymia for every one male sufferer of these disorders. This 2:1 ratio exists regardless of ethnic background. Conversely, manic depression (bipolar disorder) tends to affect equal numbers of men and women. Evidence suggests that gender differences with regard to incidence of depression are absent in childhood, emerge in adolescence, and may lessen in old age. Women are subject to several unique circumstances that may in part account for the disproportionate number of female depression sufferers over male depression sufferers.
Adolescence
Stresses apparent in adolescence include identity formation, separation from parents, emerging issues of sexuality, and decision making. The accompanying physical, intellectual, and hormonal changes are different for boys and girls and may in part account for the higher levels of depression seen in females in this age group.
Adulthood
It is well known that stress in general can contribute to depression in biologically susceptible individuals. The higher rates of depression in women may be due in part to the unique stresses many women face. Women must often juggle responsibilities of both home and work. Many are single parents raising children single-handedly or acting as primary caregivers for aging parents. How these factors may relate to the development of depression in women is an area of active research.
Reproductive Events
Hormonal changes associated with the menstrual cycle, pregnancy, the postpartum period, and menopause may cause mood fluctuations, including depressive symptoms, in some women. Scientists have confirmed that hormones have an effect on the brain chemistry that controls emotions and mood. Premenstrual syndrome (PMS) is characterized by symptoms such as depressed feelings, irritability, and other physical and emotional changes. The symptoms (sometimes severe) occur regularly in response to fluctuating hormone levels associated with the menstrual cycle. Pregnancy, if it is desired, usually does not contribute to depression. However, motherhood at a young age may be associated with greater risk for depression due to the stress and demands that it imposes. Infertility problems may induce feelings of extreme anxiety or sadness in women, although it is unclear whether this issue contributes to the higher rate of depressive illness in women.
Postpartum Depression
Postpartum mood disturbance is very common. Up to 85% of new mothers report some symptoms of mood disorder in the days to months following the birth of their child. Women who have either a personal or familial history of mood disturbance are at increased risk of developing mood disorders postpartum. Marital discord, lack of adequate social support, and recent stressful life events are additional risk factors predisposing a woman to postpartum depression. Fluctuating hormone levels also may play a role in the origin of these disorders. Both estrogen and progesterone levels fall dramatically within the first 48 hours of giving birth. The extent to which these falling hormone levels may contribute to the emergence of postpartum mood disorders, however, is unknown. Postpartum depression may range from transitory feelings of the blues lasting no more than a few days to full-blown psychosis requiring hospitalization.
The mildest form of postpartum mood disturbance is called the postpartum blues or the baby blues. Affecting 50% to 85% of all new mothers, the disorder appears within the first week after giving birth and spontaneously resolves usually by the tenth postpartum day. Irritability, anxiety, crying, and fluctuation in mood characterize the disorder. Generally, if symptoms are mild and do not impair the mother's ability to function, no treatment is needed. Many women find that talking about their feelings with a trusted friend, keeping a diary, joining a support group, eating a balanced diet, and engaging in moderate exercise may be all that is needed to sustain them through this period of the blues.
On the other hand, postpartum depression is more severe and lasts longer than the blues. The symptoms associated with this disorder, afflicting 10% to 15% of new mothers and emerging from 24 hours to several months after delivery, may include:
- depressed mood
- reduced appetite
- reduced energy/motivation to engage in activities
- feelings of worthlessness, guilt, or hopelessness
- thoughts of suicide
- fears of hurting self or baby
- feelings of restlessness, anxiety (panic), irritability
- sleep difficulties: oversleeping or difficulty falling or staying asleep
- increased tendency to cry
Many women are effectively treated with antidepressant medications such as fluoxetine, sertraline (both SSRIs antidepressants), and venlafaxine (an SNRI antidepressant). Tricyclic antidepressants may be used for women with significant sleep disturbance. Nursing mothers should be aware that antidepressant medications are secreted into breast milk. While preliminary studies suggest that small levels of antidepressant medication in breast milk are safe, the long-term effects of the drugs on the baby's developing brain are unknown. For women unwilling to undergo treatment with antidepressant medication because they are nursing, short-term cognitive behavioral therapy and interpersonal therapy may be effective options. These therapies may be used on their own or in addition to antidepressant medication.
Postpartum psychosis, the most rare mood disorder, afflicts only 0.1% to 0.2% of new mothers, usually within the first two weeks of delivery. The symptoms of the disorder may be dramatic and may include elated or euphoric mood cycling with depression (characteristic of bipolar disorder), mental confusion, disorientation, erratic, disorganized behavior, and delusional beliefs usually centering on the child. Most women experiencing postpartum psychosis suffer from bipolar disorder. Treatment usually involves hospitalization and treatment with mood stabilizers. Up to 70% of women experiencing postpartum psychosis will suffer another episode associated with subsequent pregnancy and delivery. Some physicians advocate the preventive use of antidepressant medication to avoid recurrences of postpartum depressive symptoms in subsequent pregnancies and deliveries.
Personality and Psychology
Some experts have suggested that the traditional upbringing of girls may foster traits associated with higher rates of depression in women. Certain characteristics such as pessimism, low self-esteem, excessive worrying, and having a sense of loss of control over life events may contribute to the etiology of depression. These traits may increase the severity of a woman's perception of stressful life events or interfere with her ability to take constructive action to cope with them. Others have suggested that women are no more vulnerable to depression than men. Simply, women and men report their symptoms differently. It is more socially acceptable for women to admit feelings of depression, while men may be conditioned to deny their feelings or attempt to bury them by abusing alcohol. Higher rates of alcoholism are reported for men than for women.
Victimization
Studies have shown that women who were sexually molested as children or raped as adults are more likely to be clinically depressed than women who were never victimized. Women experiencing physical abuse or sexual harassment at work are also subject to higher rates of depression. Abuse may lead to feelings of low self-esteem, hopelessness, self-blame, and social isolation. These conditions may be implicated in the development of depression.
Poverty
Women and children represent 75% of this country's poor population. Stress accompanies low economic status. Sadness and low morale are common among people living in poverty due to isolation, uncertainty, frequent negative events, and limited access to helpful resources. Whether these factors contribute to the higher rates of depression among women remains to be determined.
Depression in Later Adulthood
Women who are susceptible to depression during menopause and while experiencing the changes associated with later life are usually those with a prior history of depressive illness. Proponents of the empty nest syndrome state that women experience a profound loss of purpose and identity when children leave home. However, studies show that most elderly people feel satisfied with their lives. Depression should not be dismissed as a normal consequence of later life. Of the 800,000 people widowed in this country every year, most of them are elderly women who experience varying degrees of depressive symptoms. While grief is a normal reaction to the loss of a loved one, clinical depression is not. Approximately one-third of widows become clinically depressed after the death of their spouse and one-half of these remain depressed one year later. Medication and various psychosocial treatments, including self-help groups, are helpful in alleviating lingering depression.
